Provider Demographics
NPI:1477878403
Name:LEVY, SCOTT JORDAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JORDAN
Last Name:LEVY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 EAST 48TH ST.
Mailing Address - Street 2:SUITE 1702
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:212-744-3928
Mailing Address - Fax:212-319-9778
Practice Address - Street 1:18 EAST 48TH ST.
Practice Address - Street 2:SUITE 1702
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-744-3928
Practice Address - Fax:212-319-9778
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037740122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist